<!DOCTYPE html>
<html>
  <head>
    <title>Capture Photo</title>

	<link rel="stylesheet" href="http://code.jquery.com/mobile/1.3.1/jquery.mobile-1.3.1.min.css" />
	<script src="http://code.jquery.com/jquery-1.9.1.min.js"></script>
	<script src="http://code.jquery.com/mobile/1.3.1/jquery.mobile-1.3.1.min.js"></script>    
    <script type="text/javascript" charset="utf-8" src="cordova-2.7.0.js"></script>
    <script type="text/javascript" src="js/camera.js"></script>
    <script type="text/javascript" charset="utf-8">
    	app.initialize();
    </script>
  </head>
  
 <body>

<div data-role="page">

	<div data-role="header" class="ui-bar ui-bar-b" align="center" style="padding: 15px 0px 15px 0px;">
		Hotel Registration
	</div><!-- /header -->

	<div data-role="content">
	    <div align="center" ><h3>All fields are Mandatory</h3></div>
	    <form action="camera.html" method="post" data-ajax="false">
		    <div data-role="fieldcontain">
				<label for="owner-name">Owner Name</label>
				<input type="text" name="owner-name" id="owner-name" value="" placeholder="Full Name" required="required">	
			</div>
		    <div data-role="fieldcontain">
				<label for="hotel-name">Hotel Name</label>
				<input type="text" name="hotel-name" id="hotel-name" value="" placeholder="Hotel Name" required="required">	
			</div>
			<div data-role="fieldcontain">
			    <label for="address-text">Address</label>
			    <textarea cols="40" rows="10" name="address-text" id="address-text" placeholder="Address"></textarea>
			</div>
			
		    <label for="state-select">State</label>
		    <select name="state-select" id="state-select">
		        <option value="delhi">Delhi</option>
		        <option value="female">Assam</option>
		        <option value="female">Uttar Pradesh</option>
		        <option value="female">Haryana</option>
		    </select>			
			
		    <label for="city-select">City</label>
		    <select name="city-select" id="city-select">
		        <option value="delhi">New Delhi</option>
		        <option value="female">Rohin</option>
		        <option value="female">GK-2</option>
		        <option value="female">Karol Bagh</option>
		    </select>
			
		    <div data-role="fieldcontain">
				<label for="mobile-no">Mobile Number</label>
				<input type="tel" data-clear-btn="true" name="mobile-no" id="mobile-no" value="" placeholder="+91-xxx-xxx-xxxx">	
			</div>		
		    <div data-role="fieldcontain">
		    	<label for="landline-no">LandLine Number</label>
    		    <input type="tel" data-clear-btn="true" name="landline-no" id="landline-no" value="" placeholder="011-xxx-xxxx">
			</div>	
			
		    <div data-role="fieldcontain">
				<label for="pan-no">Pan Number</label>
				<input type="text" name="pan-nopan-no" id="text-custid" value="" placeholder="pan number">	
			</div>	
													
		    <label for="other-id">Other ID</label>
		    <select name="other-id" id="other-id">
		        <option value="male">Adhaar Card</option>
		        <option value="female">Voter Id</option>
		        <option value="female">Driver License</option>
		        <option value="female">Passport</option>
		    </select>
		    <div data-role="fieldcontain">
				<label for="other-id-no">ID Number</label>
				<input type="number" name="other-id-no" id="other-id-no" value="" placeholder="Enter id">	
			</div>		
		    <br/>
		    
		    <input type="Submit" value="Submit" >
		    
	    </form>
	</div><!-- /content -->
</div><!-- /page -->
</body>
</html>